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Home My WebLink About411 Fairfield Dr; 17-3077; AC CHANGE OUTb'. - P lob Address: Parcel ID: CITY OF SANFORD BUILDING iPREVENTION . PERMIII'APPLICATIONi C)37 Documented Construction Value. S — 2).5.0 0 Rtts i d c lit i al Type of Work: New addition Alteration Rt:pair 0 Demo _ Cltangc of i st Move I - Description of Work: Plan Review Contact Person: Phone: - J Fax: Property Owner Information t I"hone: Name 4" Street: Y"l 1 ,Lay f`e. f —j r resident of propert ' City, State Zip: Contractor Information LtTt ? ?, Phone: -0 77 -9, "C J _ ...._.,.....,. mane -- Street; 7 i " Fax. State License No,: City, Mate Zip: r Y C C—jZZ— __....__. Name: Street: City, St, Zip: Bonding Company: Address: 777MME"T - Phon] E-mail Mortgage Lender. Address'. --- WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMt:NCEMENl 51AY ICE ;*;tJl..t° i PAYING TWICE- FOR IM:PR.OWMENTS TO YOUR PROPERTY. A NOTICE OF CCtMkIENCEMENT RECORDED AND POSTED ON TILE- JOB SITE BEFORE THE FIRST INS13EC t"ION, IF you ihi'I`t=.Nf3 TO OI ffi li FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEw OR[,< RE.CO DIN( YOUR NOT10, 01' COMMENCE M ENT. Application is hereby trade to obtain a permit to do the work and installations as indicated. 1 cf r6f,", t1i'm no vvo:t o 3i'•`t'ii i° ' ' v commenced prior to the issuance of a permit and that a]I work will be performed to meet ..tttnd.ar tis caF ti i t s i httt s in this jurisdiction. I understand that a separate permit must he secured for electri€ifl work, plumbingsigns, NO[s. furnaces, boilers, heaters, tanks, and air conditioners, etc. FRC ' 105.3 Shall be inscribed with the date ofat) plication and the code in effect as of that b ate, 514 F'dition (201 ) Florida ui!0in I Cu& Rey iced: June 30, 201 NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public record: of this county, and there may be additional permits required froth other governmental entities such as "Vater management districts, state agencies, or federal agencies. Acceptance of I permit is verification that I will notify the owner of the property of the requirements of Florida Lien Law, FS 713. The City of Sanford requires payment of a plan review fee at the time ol'pernilt submittal. A copy of the executed col'u-8ct is in order to calculate a plan review charge and will be considered the estimated construction value of the job at the time of ub I'lI . I The actual construction value will be figured based on the Current [CC Valuation Table in effect at the time the permit is issued, inDvalue, alue, accordance with local ordinance. Should Calculated charges figured off the executed contract exceed the actual construction credit will be applied to Your permit fees when the permit is issued. OWNER'S AFFIDAVIT: I certify that all of the foregoing information is accurate and that all work. will be (lone in compliance with all applicable laws regulating construe * on and zoning. A I - Signature of0wrier/Agent Prii)L-Owncr/Agent's Name Date Sigriature ofNotary-State of Florida Date Owner/ Agent is Personally Known to Me or Z Produced ID Type of ID re of Print Contractor/Agent's Nariie 9 Z/ 40, o N th State ol Florida Joanna 1. Pagan f% COMMISSION # FF206292 EXPIRES: March 4, 2019 Contractor/ Agent is . ly If . \% z Produced ID 0 oy ID 'Q Permits Required: Building n Electrical n Mechanical n Plumbing[] GasO Izocif" El Construction Type: Total Sq Ft of Bldg: Occupancy Use: Min. Occupancy Load: New Construction: Electric - # of Amps Fire Sprinkler Permit: Yes[] No R APPROVALS: ZONING: E, NGfNEER[NG: COMMENTS: 4 of Heads U' f'ILITII---'S: FIRE: Plumbing - 4 of Fixtures Flood. Zone: Fire Alarm Permit: Yes R No WASTE WAT.LK BUILDfNG: Revised: June 30. 2015 hermit Application ENDORSEMENT TO POLICY NO. 10 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PREFERRED CONTRACTORS INSURANCE COMPANY RISK RETENTION GROUP, LLC COMMERCIAL GENERAL LIABILITY POLICY BLANKET ADDITIONAL INSURED INCLUDING PRIMARY COVERAGE AND WAIVER OF SUBROGATION The section of the policy entitled III. — WHO IS AN INSURED is amended to include as an additional insured any person or organization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. The coverage afforded by this endorsement is only; (1) with respect to liability of the Additional Insured in connection with the original Member's or Named Insured's ongoing operations performed for said Additional Insured; and (2) only if the Additional Insured performs all obligations required under the Policy. The coverage afforded to an Additional Insured is limited to a claim made for a Covered Loss not covered by other insurance available to an Additional Insured, and is limited by V. — COMMERCIAL GENERAL LIABILITY CONDITIONS, paragraph 4. Other Insurance, b., of the policy, which provision applies equally to an Additional Insured and is made a part of this Endorsement. Other than as expressly modified herein, coverage for the Additional Insured is governed by the terms and conditions of this policy, including the insuring agreement. No coverage is afforded under the "products -completed operations hazard" for an Additional Insured pursuant to this endorsement. The coverage afforded to an Additional Insured under this endorsement ends as of the date of completion, abandonment or termination of the work of the original Named Insured at any jobsite, project or structure. The "work" of the original Named Insured will be deemed completed as of the date all work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or when that portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization, including another contractor or subcontractor engaged in performing operations as part of the same project. The coverage provided for the Additional Insured is only to the extent that the additional insured is held liable for the negligence or strict liability of the Named Insured. No coverage is provided for liability based upon the acts, errors and omissions of the Additional Insured. No coverage is provided to an Additional Insured for damages because of "bodily injury" to an employee of the original Named Insured, whether suit is brought or claim is made by the employee or the parent, spouse, child or sibling of such employee, or any entity seeking damages because of injury to such employee. If required by written contract: the insurance afforded by the policy to the Additional Insured shall be primary insurance, and any insurance or self-insurance maintained by the above Additional Insured shall be excess of the insurance afforded to the Named Insured and shall not contribute to it. If required by written contract or agreement: We waive any right of recovery we may have against an entity that is an Additional Insured per the terms of this endorsement because of payments we make for injury or damage arising out of "your work" done under a contract with that person or organization. Except as set forth above, all of the terms, conditions and exclusions of this policy apply and remain in effect. Policy No.: PCA5025-PC244571 Date: 09/23/2017 Time: 12:01 a.m. V 09 12 Preferred Contractors Insurance Company Risk Retention Group, LLC 27 North 27th Street, Suite 1900 Billings, Montana 59101 By: _ f1 i 1 _ Authorized Representative END 10- of 4 I R" CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) r9/21/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements . PRODUCER CONTACT NAME: Marsh & McLennan Agency LLC 9850 N.W. 41st Street PHONE 305-591-0090 FAX, 212-948-5665a/cNo: E-MAIL . certsmiami@mma-fl.comSuite100 Miami FL 33178, INSURERS AFFORDING COVERAGE NAIC # f 4SU'R A:TNational;Trust Insurance Company 20141 INSURED BARONGROLIPI i IWSURERB,:GUarantee Insurance Company 11398 The Baron Group Inc. dba SURERct.F,661 I11nsurance Company 10178BaronSignManufacturing 900 West 13th Street INSURER D : INSURER.E_:` " Riviera Beach FL 33404 INSURER F : ~_ COVERAGES CERTIFICATE NIIMRFR• 869233536 10cv101n 1 w111RAmr, . ww• M-M. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRLTR TYPE OF INSURANCE I INSD WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR GL00171514 9/23/2017 9/23/2018 EACH OCCURRENCE 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence 100,000 X MED EXP (Any one person) 5,000XCU X Contractual Liab PERSONAL & ADV INJURY 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PRO- JECT LOC GENERAL AGGREGATE 2,000,000 PRODUCTS -COMP/OP AGG 2,000,000 OTHER: C AUTOMOBILE LIABILITY CA10000485502 9/23/2017 9/23/2018 COMBINED SINGLE LIMIT Ea accident 1,000,000 X BODILY INJURY (Per person) ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) HIRED X NON -OWNEDAUTOSONLYAUTOSONLYX PROPERTY DAMAGE Per accident)$ C X UMBRELLA LIAB X OCCUR UMB10001671801 9/23/2017 9/23/2018 EACH OCCURRENCE 5,000,000 AGGREGATE 5,000,000 EXCESS LIAR CLAIMS -MADE DED X RETENTION $10,000 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER!MEMBER EXCLUDED? F N / A WCP102090801GIC 1/1/2017 1/1/2018 PER OTH- X STATUTE ER E.L. EACH ACCIDENT 1,000,000 E.L. DISEASE - EA EMPLOYEE 1,000.000MandatorydorybeandIfyes, describe under E.L. DISEASE -POLICY LIMIT 1,000,000DESCRIPTIONOFOPERATIONSbelow DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Proof of Insurance only. w"- iL AIVLCLLA I IUIV City of Sanford Attn: Joann 300 North Park Avenue Sanford FL 32771 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 44a, 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD OY OF SXNFORD FIRE DEPARTMENT PERMIT NO.... I 1- 30 11 ISSUE DA CONTRACTOR JOB ADDRESS: TYPE OF WORK: A I Building & Fire Prevention Division Residential Permit Card Post this permit in a conspicuous location outside Approved plans must be posted with permit for inspection Leave all work uncovered until inspected and approved Permit expires 6 months from date of issue or last approved inspection PROTECT FROM WEATHER BUILDING INSPEC77ON TYPE APPROVED REIECT£D INSPECTOR ELECTRICAL INSPEC77ON TYPE APPROVED REJECTED INSPECTOR FOOTER INSPECTION ELECTRIC UNDERGROUND STEMWALL FOOTER/SLAB STEEL BOND FORMBOARD SURVEY T.U.G. / PRE POWER SLAB / MONO -SLAB ELECTRIC ROUGH LINTEL / TIE BEAM ELECTRIC FINAL SHEATHING - ROOF MECHANICAL INSPEC27ON TYPE APPROVED REJECTED INSPECTORSHEATHING - WALLS FRAME MECHANICAL ROUGH INSULATION ROUGH IN MECHANICAL FINAL DRYWALUSHEETROCK PLUMBING APPROVED REJECTED INSPECTORLATHINSPECTIONJINSPEC77ONTYPE FINAL STUCCO/SIDING UNDERGROUND ROUGH FIREWALL SCREW TUB SET FIREWALL FINAL SEWER INSULATION FINAL PLUMBING FINAL FINAL SFR GAS INSPECTIONS INSPEC77ON TYPE APPROVED REJECTED INSPECTORROOF INSPECTION TYPE APPROVED REJECTED INSPECTOR GAS UNDERGROUND PIPE ROOF DRY -IN 4-GAS ROUGH -IN FINAL ROOF GAS FINAL MISCELLANEOUS FINAL INSPECTIONS INSPEC77ON TYPE APPROVED REJECTED INSPECTOR INSPEC77ON TYPE APPROVED REJECTED INSPECTOR PRE -DEMO FINAL DOOR FINAL DEMO FINAL WINDOW FINAL SOLAR PANELS IRRIGATION FINAL FINAL POOL SCREEN FINAL SCREEN ROOM FINAL UTILITY BUILDING FINAL BUILDING (OTHER) MOBILE HOME TIE -DOWN MOBILE HOME FINAL WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. NOTICE: IN ADDITION TO THE REQUIREMENTS OF THIS PERMIT, THERE MAY BE ADDITIONAL RESTRICTIONS APPLICABLE TO THIS PROPERTY THAT MAY BE FOUND IN THE PUBLIC RECORDS OF THIS COUNTY, AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT DISTRICTS, STATE AGENCIES OR FEDERAL AGENCIES FBCI05.3.3 REVISED: 4.17 Inspection Line: 407.792.6069 or 855541.2112